"I believe in a multi-disciplinary approach to pain.........."

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"I believe in a multidisciplinary approach to pain". Have you ever read the bio or PR statement of any pain docs on their web sites? Whether academic or private practice, injections only, meds only, ect………………………………. they all say "I believe in a multi-disciplinary approach to pain". However, MOST don't practice it (but apparently just believe it) due to lack of such available resources, financial reasons, ….whatever. It almost seems like a trite, dishonest statement, that is never fully realized.

1. I DONT believe in a multi-disciplinary approach to pain. The most effective goal/treatment is core exercises, increased patient activity, and slight modification of lifting activities. EVERYTHING else that is done (injections, procedures, surgery) is just a gateway to improve pain control such that the above three goals can be met. It does not take an army of providers to instill these notions in patients, nor to orchestrate the implementation of the above. In many instances, a patient does not need an injection/procedure, surgery, psych eval, or advanced diagnostic imaging.

2. A "multi-disciplinary" approach is somewhat akin to the image of captive of native Americans who is compelled to pass through a gauntlet of parallel lines of warriors with clubs, each eager to take a whack at the prisoner. When patients are seen by multiple providers, those providers usually are compelled to do SOMETHING (even if that something may be marginally indicated) and take their "whack" at the prisoner (I mean patient). Thus, over utilization occurs when seeing other specialists is probably only indicated if there is something very specific to address.

3. Everybody in a "multi-disciplinary" approach ends up getting advanced imaging, whether they need it, or not. Not everybody with benign back pain needs an MRI.

4. Patients with acute herniated discs or subacute neurogenic claudication don't need to see a shrink. While everyone is aware that 85% plus of our patients have anxiety and depression (which may be a major factor in their pain), MANY patients sent to pain clinics are those who have more episodic acute periods of pain, rather than continually, long term pain. Such patients usually do not require the evaluation and treatment of a psychologist or psychiatrist like our chronic patients.

5. Having multiple providers of several different disciplines is expensive. We are in a state of affairs in which costs need to be addressed and reduced. Rather than a "cookie cutter", one size fits all approach, having other selected providers (when indicated) see the patient is a more rational, selective approach.

I am still searching, but I think it would be refreshing to find a bio/personal statement by a doc on a website with their smiling face and their arms folded (don't you hate that pose? When the hell did people start doing that? I tell my daughter, who is an M4, to strike her sorority girl pose, rather than the folded arm bit, when she is in practice) saying, "I think the multidisciplinary approach to pain has its merits in chronic. long term pain, it is otherwise bullcrap". I don't think I will find that anytime soon.

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"I believe in a multidisciplinary approach to pain". Have you ever read the bio or PR statement of any pain docs on their web sites? Whether academic or private practice, injections only, meds only, ect………………………………. they all say "I believe in a multi-disciplinary approach to pain". However, MOST don't practice it (but apparently just believe it) due to lack of such available resources, financial reasons, ….whatever. It almost seems like a trite, dishonest statement, that is never fully realized.

1. I DONT believe in a multi-disciplinary approach to pain. The most effective goal/treatment is core exercises, increased patient activity, and slight modification of lifting activities. EVERYTHING else that is done (injections, procedures, surgery) is just a gateway to improve pain control such that the above three goals can be met. It does not take an army of providers to instill these notions in patients, nor to orchestrate the implementation of the above. In many instances, a patient does not need an injection/procedure, surgery, psych eval, or advanced diagnostic imaging.

2. A "multi-disciplinary" approach is somewhat akin to the image of captive of native Americans who is compelled to pass through a gauntlet of parallel lines of warriors with clubs, each eager to take a whack at the prisoner. When patients are seen by multiple providers, those providers usually are compelled to do SOMETHING (even if that something may be marginally indicated) and take their "whack" at the prisoner (I mean patient). Thus, over utilization occurs when seeing other specialists is probably only indicated if there is something very specific to address.

3. Everybody in a "multi-disciplinary" approach ends up getting advanced imaging, whether they need it, or not. Not everybody with benign back pain needs an MRI.

4. Patients with acute herniated discs or subacute neurogenic claudication don't need to see a shrink. While everyone is aware that 85% plus of our patients have anxiety and depression (which may be a major factor in their pain), MANY patients sent to pain clinics are those who have more episodic acute periods of pain, rather than continually, long term pain. Such patients usually do not require the evaluation and treatment of a psychologist or psychiatrist like our chronic patients.

5. Having multiple providers of several different disciplines is expensive. We are in a state of affairs in which costs need to be addressed and reduced. Rather than a "cookie cutter", one size fits all approach, having other selected providers (when indicated) see the patient is a more rational, selective approach.

I am still searching, but I think it would be refreshing to find a bio/personal statement by a doc on a website with their smiling face and their arms folded (don't you hate that pose? When the hell did people start doing that? I tell my daughter, who is an M4, to strike her sorority girl pose, rather than the folded arm bit, when she is in practice) saying, "I think the multidisciplinary approach to pain has its merits in chronic. long term pain, it is otherwise bullcrap". I don't think I will find that anytime soon.
multi-disciplinary is not the same as every modality known to mankind is going to be utilized. it simply means that a physician has more than one option for treatment. the smarter the doc, the more tailored the treatment. if every modality was thrown at every patient there would be no need for an evaluation. no one does things that way. too $$.
 
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Got a PCP who just sent referral for 92 y/o. Fent 25, oxy30#120, Ultram. 270meq.
Denied.

I wonder why they weren't on 200 of lyrica bid, 32 mg Zanalfex, Soma, and 200mg of amitriptyline? Doesn't he know there are other receptors to be abused?
 
"I believe in a multidisciplinary approach to pain". Have you ever read the bio or PR statement of any pain docs on their web sites? Whether academic or private practice, injections only, meds only, ect………………………………. they all say "I believe in a multi-disciplinary approach to pain". However, MOST don't practice it (but apparently just believe it) due to lack of such available resources, financial reasons, ….whatever. It almost seems like a trite, dishonest statement, that is never fully realized.

1. I DONT believe in a multi-disciplinary approach to pain. The most effective goal/treatment is core exercises, increased patient activity, and slight modification of lifting activities. EVERYTHING else that is done (injections, procedures, surgery) is just a gateway to improve pain control such that the above three goals can be met. It does not take an army of providers to instill these notions in patients, nor to orchestrate the implementation of the above. In many instances, a patient does not need an injection/procedure, surgery, psych eval, or advanced diagnostic imaging.

2. A "multi-disciplinary" approach is somewhat akin to the image of captive of native Americans who is compelled to pass through a gauntlet of parallel lines of warriors with clubs, each eager to take a whack at the prisoner. When patients are seen by multiple providers, those providers usually are compelled to do SOMETHING (even if that something may be marginally indicated) and take their "whack" at the prisoner (I mean patient). Thus, over utilization occurs when seeing other specialists is probably only indicated if there is something very specific to address.

3. Everybody in a "multi-disciplinary" approach ends up getting advanced imaging, whether they need it, or not. Not everybody with benign back pain needs an MRI.

4. Patients with acute herniated discs or subacute neurogenic claudication don't need to see a shrink. While everyone is aware that 85% plus of our patients have anxiety and depression (which may be a major factor in their pain), MANY patients sent to pain clinics are those who have more episodic acute periods of pain, rather than continually, long term pain. Such patients usually do not require the evaluation and treatment of a psychologist or psychiatrist like our chronic patients.

5. Having multiple providers of several different disciplines is expensive. We are in a state of affairs in which costs need to be addressed and reduced. Rather than a "cookie cutter", one size fits all approach, having other selected providers (when indicated) see the patient is a more rational, selective approach.

I am still searching, but I think it would be refreshing to find a bio/personal statement by a doc on a website with their smiling face and their arms folded (don't you hate that pose? When the hell did people start doing that? I tell my daughter, who is an M4, to strike her sorority girl pose, rather than the folded arm bit, when she is in practice) saying, "I think the multidisciplinary approach to pain has its merits in chronic. long term pain, it is otherwise bullcrap". I don't think I will find that anytime soon.

I heal with hollow steel ....
 
The folded arms is because men don't know what to do with their arms when they're taking a full body picture. We just took a group photo. Awkward arms everywhere.
 
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It just makes it someone's else's problem.
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Got a PCP who just sent referral for 92 y/o. Fent 25, oxy30#120, Ultram. 270meq.
Denied.

I call that a hot potato. No one wants to be the last prescriber before he dies.
 
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The folded arms is because men don't know what to do with their arms when they're taking a full body picture. We just took a group photo. Awkward arms everywhere.

At least we dont all try to pull off the skinny arm look with the internally rotated shoulder, and hand on hip. We know what you're up to, btw. All 8 of you in the pic have the same arm stance....
 
there is multiple data that suggests that Medicaid patients do not do as well as private pay.

even websites and calculators. for example:


fwiw, here is a comparison based on this calculator between 2 patients, both female, age 50 with radiculopathy with lumbar fusion and I left all other data points exactly the same and did not change any (for simplicity sake):
(could not snip nor copy the pages so I just copied the data)

Private Pay:
77.2% chance of improvement in disability in a year, 30.5% chance of minimal disability

84.6% chance of improvement in back pain in a year, 50.2% chance of minimal back pain

86.7% chance improvement in leg pain, 53.89% chance of minimal leg pain in a year.

Medicaid:
56.6% chance improvement in disability in a year, 9.71% chance of minimal disability

69% chance of improvement in back pain in a year, 30% chance of minimal back pain

83.1% chance of improvement in leg pain, 42.9% chance of minimal leg pain in a year

Labor and Industry:
40.4% chance of improvement in disability in a year, 14.9% chance of minimal disability

74.2% chance of improvement of back pain in a year, 30.8% chance of minimal back pain

75.8% chance improvement of leg pain, 38.8% chance of minimal leg pain in a year.....

so not as well as private pay, better than WC.....
 
yes so that is hard to read...

in another format:
chance of improvement of disability in a year: Private pay 77.2%, Medicaid 56.6%, WC 40.4%
chance of minimal disability in 1 year: Private pay 30.5%, Medicaid 9.71%, WC 14.9%.

back pain in a year: private pay 84.6%, Medicaid 69%, WC 74.2%
minimal back pain in a year: private pay 50.2%, Medicaid 30%, WC 30.8%.
 
yes so that is hard to read...

in another format:
chance of improvement of disability in a year: Private pay 77.2%, Medicaid 56.6%, WC 40.4%
chance of minimal disability in 1 year: Private pay 30.5%, Medicaid 9.71%, WC 14.9%.

back pain in a year: private pay 84.6%, Medicaid 69%, WC 74.2%
minimal back pain in a year: private pay 50.2%, Medicaid 30%, WC 30.8%.

Government programs are a risk factor for all kinds of poor outcomes.
 
Government programs are a risk factor for all kinds of poor outcomes.
Especially those malingering medicare patients, old people are the worst
 
Government programs are a risk factor for all kinds of poor outcomes.
agree yet disagree.

the question is - are government programs the risk factor, or are patients themselves the risk factor and then more likely to end up in government programs? I believe the latter...

and linking to hawkeye's thread - these patients need a multidisciplinary program, involving a physician and, short term, physical therapy and cognitive behavioral therapy.
 
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